Symptoms of neurodegenerative diseases

Laforce, Robert; Lehmann, Manja; Macoir, Joël; Poulin, Stéphane; Roy, Martin; Soucy, Jean‐Paul; Verret, Louis; Miller, Bruce L.; Bouchard, Rémi W.

doi:10.1093/med/9780199671618.003.0005

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“…Neurodegenerative diseases stem from insidious damage to cells and connections in the nervous system that are essential for cognition, behavior, mobility, autonomic functions, and communication [ 1 ]. Neurodegenerative diseases presenting in infancy and early childhood are characterized by a lack of attainment of developmental milestones, delays in reaching developmental milestones, and/or loss of acquired developmental milestones after a period of plateau.…”

Section: Introductionmentioning

confidence: 99%

Strategy for Generating Blinded Evidence for Single-Arm Trials with External Controls Using Expert Review of Home Video

Zhang,

Brind’Amour,

King

et al. 2023

Ther Innov Regul Sci

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Introduction Neurodegenerative diseases cause developmental delays and loss of milestones in infants and children. However, scalable outcome measures that quantify features meaningful to parents/caregivers (P/CGs) and have regulatory precedence are lacking for assessing the effectiveness of treatments in clinical trials of neurodegenerative disorders. To address this gap, we developed an innovative, blinded strategy for single-arm trials with external controls using expert panel review of home video. Method We identified meaningful, observable, and objective developmental milestones from iterative interviews with P/CGs and clinical experts. Subsequently, we standardized video recording procedures and instructions to ensure consistency in how P/CGs solicited each activity. In practice, videos would be graded by an expert panel blinded to treatment. To ensure blinding and quality control, video recordings from interim time points would be randomly interspersed. We conducted a pilot study and a pretest of grading to test feasibility and improve the final strategy. Results The five P/CGs participating in the pilot study found the instructions clear, selected activities important and reflective of their children’s abilities, and recordings at-home preferrable to in-clinic assessments. The three grading experts found the videos easy to grade and the milestones clinically meaningful. Conclusion Our standardized strategy enables expert panel grading of developmental milestone achievements using at-home recordings, blinded to treatment and post-baseline time points. This rigorous and objective scoring system has broad applicability in various disease contexts, with or without external controls. Moreover, our strategy facilitates flexible, continued data collection and the videos can be archived for future analyses.

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Section: Introductionmentioning

confidence: 99%